{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH  L BRILL","gend":0,"add":"918 S BUCHANAN ST APT 101","city":"ARLINGTON","state":"VA","zip":"22204-9998","dob":"1963-07-05","age":"","mstatus":"","insh":"20045980*01","cliId":"","pno":7034864721,"cno":7034864721,"email":"","ename":"","eno":"","pphy":"HOLTAN, DANIEL MD","ppno":7035355568,"pcpadd":"2120 WASHINGTON BLVD,","pcpcity":"ARLINGTON","pcpstate":"VA","pcpzip":"22204-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7032991794,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R52.","F29.","F48.9","F60.2","F12.10","F17.200","M79.604","V62.84","M54.9","M25.521","M77.11","M19.021","F31.9","F32.2","M25.561","M51.36","R73.03","NO DATA","M47.816","M54.16","M62.830","M54.6"],"date":["2021-02-02","2023-04-05","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-02-07","2021-02-07","2021-03-07","2022-10-14","2022-10-14","2022-10-14","2021-02-15","2021-03-11","2023-01-11","2023-01-11","2023-01-11","2022-04-07","2022-04-07","2022-04-07","2022-03-25","2022-03-25"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877024601","QUETIAPINE TAB","200MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","00054001829","PREDNISONE TAB","20MG","15","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","90","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","00713022615","TRIAMCINOLONE ACETONIDE","0.025 %","60","Select","Select",""],["","67877024601","QUETIAPINE FUMARATE","200 MG","30","Select","Select",""],["","00093321992","KETOCONAZOLE","2 %","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}